Provider Demographics
NPI:1235425281
Name:ELLIS, BERNADETTE ROSSI
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ROSSI
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 WESTHEIMER RD
Mailing Address - Street 2:T-2139
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-4201
Mailing Address - Country:US
Mailing Address - Phone:713-331-0374
Mailing Address - Fax:713-331-0374
Practice Address - Street 1:8605 WESTHEIMER RD
Practice Address - Street 2:T-2139
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-4201
Practice Address - Country:US
Practice Address - Phone:713-331-0374
Practice Address - Fax:713-331-0374
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist